CPT 77046Radiology

Mri breast c- unilateral

CPT code 77046 covers an MRI scan of one breast performed with contrast material (dye) injected into the vein to help detect cancer, evaluate implants, or assess abnormal findings from other imaging tests.

Showing rates for

National Average

Base Medicare rate

$208.63

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.45

PE RVU (NF)

4.92

MP RVU

0.08

Total RVU

6.45

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always append RT or LT modifier to specify laterality on initial claim submission
Impact: Prevents 15-25% of claims from being rejected or delayed for missing laterality information; ensures accurate tracking for bilateral screening protocols
Verify contrast administration is documented in both technical protocol notes and radiologist interpretation before billing 77046
Impact: Contrast documentation gaps cause 30-40% of audits to downgrade to non-contrast code 77045, reducing payment by approximately $50-70
Obtain and document medical necessity with diagnosis codes supporting high-risk screening (Z80.3, Z15.01) or diagnostic workup (R92.8, C50.x)
Impact: Inadequate medical necessity is the leading cause of denials for screening MRI; proper coding increases first-pass acceptance rate by 45%
Bill 77046 and 77047 separately on same date when bilateral MRI is performed rather than using bilateral modifier
Impact: Ensures full payment for both sides ($208.63 x 2 = $417.26) versus potential 50% reduction on second side with bilateral modifier
Verify patient has not had MRI of same breast within past 12 months unless medical necessity clearly documented for interval change
Impact: Frequency limitations cause 20% of denials; documentation of new symptoms or findings can overturn these denials and secure the $208.63 payment
Split bill professional (26) and technical (TC) components when services occur in different settings or involve different providers
Impact: Prevents claim rejections for duplicate billing and ensures appropriate payment distribution between facility and reading physician

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77046 in 2025?

The 2025 Medicare national average reimbursement for CPT 77046 is $208.63 for both facility and non-facility settings. This rate is based on 6.45 total RVUs (1.45 work RVU, 4.92 practice expense RVU, 0.08 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT code 77046 and 77047?

CPT 77046 covers MRI of one breast (unilateral) with contrast, while 77047 covers MRI of both breasts (bilateral) with contrast. When both breasts are imaged during the same session, bill each side separately using 77046 with RT modifier and 77047 with LT modifier, or use 77047 alone depending on payer preference.

Does CPT 77046 require prior authorization from Medicare or private insurance?

Medicare typically does not require prior authorization for diagnostic breast MRI with appropriate medical necessity documentation, but many Medicare Advantage and commercial payers do require pre-authorization, especially for screening indications. Always verify payer-specific requirements before scheduling, as authorization policies vary significantly by plan.

Can CPT 77046 be billed with a screening mammogram on the same day?

Yes, CPT 77046 can be billed with screening mammography (77067) on the same day if both are medically necessary and documented separately. However, many payers prefer these services on different dates for screening protocols. Diagnostic mammography followed by MRI for problem-solving is commonly accepted when properly documented with appropriate modifiers if needed.

What diagnosis codes support medical necessity for CPT 77046?

Strong diagnosis codes include Z15.01 (genetic susceptibility to breast cancer), Z80.3 (family history of breast cancer), R92.8 (abnormal mammogram findings), C50.x (personal history or current breast cancer), N60.x (benign breast conditions requiring further evaluation), and Z86.000 (personal history of breast cancer). High-risk screening requires documentation of lifetime risk >20%.

How many RVUs is CPT code 77046 worth in 2025?

CPT 77046 has a total of 6.45 RVUs in 2025, consisting of 1.45 work RVUs, 4.92 practice expense RVUs (same for facility and non-facility), and 0.08 malpractice RVUs. This RVU value reflects the professional work, practice costs, and liability insurance costs associated with performing and interpreting the breast MRI.

Is contrast material always required when billing CPT 77046?

Yes, CPT 77046 specifically describes breast MRI with contrast material. If the exam is performed without contrast, the appropriate code is 77045. If both without and with contrast are performed during the same session, only the with-contrast code (77046) should be reported as it includes all sequences. Contrast administration must be documented in the medical record to support billing 77046.